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Published on July 11, 2017

Vascular Imaging Technology Enhances Preoperative Planning

volume rendering 3D
reconstruction of the entire aorta and iliac vessels

The 3mensio shows volume rendering 3D
reconstruction of the entire aorta and iliac vessels
with associated centerline technology. The
adjacent images illustrate the axial centerline with
diameter measurements for endograft sizing.

Vascular surgeons at North Kansas City Hospital now have an innovative system that helps optimize stent sizing and placement during endovascular repair of abdominal and thoracic aortic aneurysms. With the precise 3-D visualization of 3mensio Vascular™ software, surgeons can treat patients with the most intricate aneurysm repairs via a minimally invasive approach.

Endovascular Treatment

James F. Foster III, MD, a vascular surgeon with the Midwest Aortic and Vascular Institute, appreciates how an endovascular approach for the treatment of difficult anatomy gives patients improved outcomes over open surgery.

Although time-tested, open surgical aneurysm repairs require a considerable amount of dissection and elaborate reconstruction. “Open surgeries have a significant increase in complications, intensive care unit stays and perioperative morbidity,” Dr. Foster said.

Albeit many patients benefit from off-the-shelf grafts, until recently endovascular surgery was not an option if a standard-size graft did not fit the damaged area.

We didn’t know how a graft would lay inside an aneurysm,” Dr. Foster said. “These patients are very ill and have multiple comorbidities. With this system, we have more endovascular options and better outcomes.”

How 3mensio worksSized to Fit

Before placing a stent, Dr. Foster uses 3mensio to determine which stent best anatomically suits the patient’s pathology. The system automatically detects relevant measurements, including diameter, position, volume and length.

“Planning has a direct impact on outcomes, so knowing everything you can possibly know about a patient’s aneurysm before you get into the operating room is paramount,” Dr. Foster said, pointing to the software’s ability to detect a large calcium burden or positioning for cannulating vessels.

“I know the exact center of a vessel the entire way through a tortuous aneurysm. That allows me to determine which graft size to use and how it will lay. If it’s a typical aortic aneurysm, I can use an off-the-shelf graft,” Dr. Foster explained. “If it’s not, this system gives me more accurate sizing capabilities.”

With the ability to accurately align the graft, Dr. Foster can decrease time in surgery and the amount of radiation exposure to the patient and staff.

Complex Aneurysms

James Foster, MD

James F. Foster III, MD

Dr. Foster earned his medical degree from the University of Missouri-Kansas City, where he completed his residency in general surgery and was chief surgical resident. He also completed a fellowship in vascular surgery at the University of Iowa Hospitals and Clinics in Iowa City.

The 3mensio shows volume rendering 3D reconstruction of the entire aorta and iliac vessels with associated centerline technology. The adjacent images illustrate the axial centerline with diameter measurements for endograft sizing.

The pinpoint accuracy also applies to complex aneurysms, which require custom-made fenestrated grafts. Reinforced tailored openings that branch out of these grafts allow surgeons to precisely line up the graft with other vessels coming off the aneurysm, allowing them to maintain forward blood flow through the branches and still treat the aneurysm.

“Everyone’s anatomy is different, and everyone’s aneurysms are different. We still treat a lot of them successfully with off-theshelf grafts, but 3mensio allows us to choose those off-the-shelf grafts more appropriately and to custom fit specific grafts, all while giving many patients an endovascular option when they otherwise were not candidates for endovascular surgery.

Open vs. Endovascular